The ultimate goal of this program of research is to maximize positive health outcomes for those with cancer by creating opportunities for individuals to fully express themselves regarding cancer symptoms and quality of life concerns. However, clinicians are faced too often with shrinking resources, removing opportunities for comprehensive, interpersonal interactions with patients. Patient-reported outcomes and status, particularly symptoms and quality of life (QOL) concerns, reported in a reliable and systematic way, are essential components of the information on which a complete clinical assessment, diagnosis and treatment plan is based. In our previous clinical trial, having intervened by giving screening results to providers, we demonstrated the feasibility, acceptability and efficacy of patient symptom and QOL outcome screening at a large comprehensive cancer center. We have established the ability of the electronic self-report assessment-cancer (ESRA-C) to improve the patient-clinician conversation regarding symptoms or QOL issues (SQI), yet certain key questions remain relevant to the ability of the patient and family caregivers to describe and present, without hesitation, the symptom and quality of life issues that are of concern. We have evidence that certain symptoms (e.g., cognitive dysfunction) are underreported in face-to-face clinic visits. Being able to communicate such concerns to a clinical provider, requires that the patient and/or caregiver understand the concern is important, have a convenient time, place and method to communicate and that the clinical providers will acknowledge and address the concern. The purpose of this study is to further evaluate the clinical, and newly evaluate the remote, use of our enhanced web-based, electronic self-report assessment program for cancer, ESRA-C. In addition to the ESRA-C summary given to clinicians, highlighting areas of concern, our system will provide a customized summary in a format that is useable by patients and coach each patient with three messages: a) why and how often this SQI typically occurs in patients like you, b) it can be dealt with, and c) how to talk to your clinical providers about the SQI. These messages will assist patients in face-to-face clinic meetings with the providers, facilitating patient expression and communication regarding issues for which the patient is the expert, cancer related symptoms and QOL concerns. This two- pronged approach to enhancing communication, delivered to both providers and patients, is hypothesized to be a powerful adjunct to excellent clinical monitoring and care. The purpose of this competitive supplement is to describe the natural history of symptomatology over the course of treatment and identify key SQI predictors of important clinical processes and outcomes, notably adherence and dose modifications, plus evaluate the impact on clinical processes of direct integration of self-assessed SQI data into the electronic medical record (EMR) in the routine implementation phase. PUBLIC HEALTH RELEVANCE: Patients with cancer, across a wide range of diagnoses and stages, have a high incidence of symptoms that may greatly impact quality of life. Patient-reported outcomes and status, particularly symptoms and quality of life concerns, reported in an efficient, reliable and systematic way, are essential components of the information on which a complete clinical assessment, diagnosis and treatment plan is based.